|Publication number||US3982542 A|
|Application number||US 05/557,469|
|Publication date||Sep 28, 1976|
|Filing date||Mar 12, 1975|
|Priority date||Mar 12, 1975|
|Publication number||05557469, 557469, US 3982542 A, US 3982542A, US-A-3982542, US3982542 A, US3982542A|
|Inventors||John L. Ford, John Serafin|
|Original Assignee||Ford John L, John Serafin|
|Export Citation||BiBTeX, EndNote, RefMan|
|Patent Citations (7), Referenced by (37), Classifications (10), Legal Events (1)|
|External Links: USPTO, USPTO Assignment, Espacenet|
This invention relates to surgical instruments.
More specifically, the invention relates to an electrically energized resectroscope.
In a further aspect, the instant invention concerns an electroresectroscope for laparoscopic tubal sterilization.
During the past several years, beginning in the latter part of the previous decade, laparoscopy has become one of the more commonly performed gynecologic procedures. As a direct result, laparoscopic tubal sterilization is now widely accepted as the standard method of female sterilization.
The procedural mechanics are relatively simple. After the patient is anesthesized, a cannula is inserted through the abdominal wall for insufflation of the peritoneal cavity. A laparoscope, through which the surgeon views the procedure, is introduced into the peritoneal cavity. The tubal sterilization is then accomplished by electroresection. Conventionally, the electroresection is accomplished through a small opening provided by a trocar and generally consists of electrocoagulating a section of the Fallopian tube and subsequently severing the tube within the coagulated area to produce a separation of fulgurated ends.
Substantial medical activity and effort have been directed to the development of laparoscopic tubal sterilization and reducing complications associated therewith. The effort includes perfecting the surgical procedure and the production of advanced laparoscopic instruments.
Regardless of the advance of medical procedures and the inherent mechanical simplicity of the operation, complications frequently arise during a laparoscopic tubal sterilization. The majority of complications are in connection with the performance of the tubal electrosurgery. During electrosurgery, the patient and the surgeon are potentially subjected to electrosurgical burns. During surgery, the coagulating tip is the active electrode which concentrates the current at the point of application. The active electrode is manually controlled by the surgeon. The circuit is completed by a disbursive electrode or ground plate in broad contact with the skin. The current is therefore caused to pass through the patient from the point of operation to the ground plate. If the ground is inadequate or defective, the current will flow through any available low-resistance path. High voltage/high frequency electricity is not infrequently responsible for abdominal wall burns and perferating the bowel.
During electrosurgery, the coagulating electrode is in close proximity to surrounding tissues and other operative instruments. It is not uncommon for the coagulating tip to obliterate the blood supply to the ovary. This is thought to be the cause of menstrual problems and early menopause in young females. Surgeons have reported facial burns when the tip of the laparoscope inadvertently short-circuited against the active electrode.
Record is made of pregnancy subsequent to laparoscopic tubal sterilization in which the Fallopian tubes were coagulated, but not resected.
In view of the foregoing discussion, it would be highly advantageous to reduce complications associated with laparoscopic tubal sterilization.
Accordingly, it is a principal object of the present invention to provide an improved method of performing a laparoscopic tubal sterilization and an improved surgical kit including instruments for use therewith.
Another object of the instant invention is the provision of a resectroscope for simultaneous elecctrorescetion ad electrocoagulation of a Fallopian tube. electroresection
still another object of the invention is the electrosurgery of specified tissue in a shielded environment for the prevention of thermal burns to adjacent organs.
Yet another object of the invention is the performance of electrosurgical tubal sterilization in which the isolated operative tissue is subjected to a localized electrical current.
Yet still a further object of the present invention is the simplification of the laparoscopic tubal sterilization procedure, while reducing the complications heretofore associated therewith.
Briefly, to achieve the desired objectives of the present invention, first provided is a trocar comprising an elongate sheath and a first elongate stylet having a surgically incisive tip slidably received through the sheath. The surgically incisive tip provides an incision for entry of the trocar into the abdominal cavity and placement of the forward end of the sheath in the surgical area. Also provided is a second stylet similarly slidably received within the sheath and having an elongate shaft with a hook-shaped electrical resistance heating element extending from the forward end thereof. Means are provided for transmitting a controlled predetermined electrical energy impulse to the heating element.
After the sheath is positioned as above described, the first stylet is withdrawn and the second stylet inserted until the heating element extends beyond the forward end of the sheath. A Fallopian tube is engaged by the hook-shaped heating element. Rearward movement of the second stylet relative the sheath retracts the resistance element and a portion of doubled Fallopian tube engaged therewith within the thermoelectric insulating end of the tubular sheath. Applying electrical energy to the resistance element simultaneously coagulates and severs the Fallopian tube within a shielded environment.
The foregoing and further and more specific objects and advantages of the present invention will become immediately apparent to those skilled in the art from the following detailed description thereof, taken in conjunction with the drawings, in which:
FIG. 1 is a partial perspective view of a resectroscope apparatus constructed in accordance with the teachings of the present invention;
FIG. 2 is a vertical sectional view of a trocar for use in connection with the apparatus of FIG. 1;
FIG. 3 is an elevational view, partly in section, of the resectroscope of FIG. 1;
FIG. 4 is a slightly enlarged horizontal sectional view of the device of FIG. 3, taken along the line 4--4 thereof;
FIG. 5 is a fragmentary perspective view of the electroscope of FIG. 3 as it would appear when first engaging a Fallopian tube; and
FIG. 6 is a fragmentary perspective view, partly broken away, illustrating the resectroscope as it would appear during a subsequent stage of the operation.
Turning now to the drawings, in which the same reference numerals indicate corresponding elements throughout the several views, attention is first directed to FIG. 1, which shows the resectroscope, generally designated by the reference character 10, and a power supply, generally designated by the reference character 11, for providing a predetermined electrical energy impulse thereto. The resectroscope 10 includes an elongate tubular sheath 12 and an elongate stylet 13 slidably received therein, as will be hereinafter described in detail.
The power supply 11, in accordance with a preferred embodiment thereof, utilizes a nickel-chrome gel battery to provide an electrical output of 6 volts direct current at 10 amperes. Two pair of female receptacles 17 and 18 are arranged upon the face 19 of power supply 11. Male connector 20 is immovably received within receptacles 17 for transmission of electrical current through leads 21 to energize resectroscope 10. Male connector 22 is slidably received in receptacles 18 for activation of power supply 11 by foot switch 23 through leads 24. Test lights 27, 28 and 29 indicate the condition of the battery. In accordance with standard practice, the lights 27, 28 and 29 are colored, respectively, green, yellow and red and indicate, respectively, that the battery is sufficiently charged, low or depleted. The appropriate light responds when momentary contact switch 30 is depressed. Lights 31 and 32 are associated with the operational mode of the unit and may indicate, respectively, operating or charging.
Circuitry and construction details of the d-c power supply 11 as above described will be immediately apparent to those skilled in the art and readily fabricated by those having an appreciation for the requirements thereof in accordance with the present invention. In this respect, it is particularly noted that the power supply 11 includes a timing mechanism which is reset and activated by foot switch 23 to provide an electrical impulse of predetermined duration to resectroscope 10. Extensive experimentation has revealed that a duration of approximately 20 seconds is optimum for performance of the operation. The d-c power supply 11, as described, provides a completely portable electrosurgical device. However, it will be appreciated and readily apparent to those skilled in the electronic art that the battery may be discarded in favor of additional circuitry for direct connection to a readily available source of alternating current.
Specifically seen in FIG. 2 is a trocar, generally designated by the reference character 33, which includes elongate tubular sheath 12. Although sheath 12 may be variously fabricated of differing materials and sizes, a stainless steel sheath approximately 8 mm. in diameter by 161/2 cm. long is preferred. Sheath 12 has a forward probe end 34 which includes a disposable thermoelectric insulating tip 35, as might be inexpensively fabricated from teflon, and removably threadedly engaged with the main portion of the sheath. An outwardly directed radial flange 38 at the rearward end 39 of sheath 12 provides a fingergrasp under which the surgeon may engage his index and middle fingers. An elongate stylet 40, having a surgically incisive tip 41 at the forward end thereof and a disk-like pad 42 at the rearward end thereof, is slidably received within tubular sheath 12. Pad 42 provides a thumbrest to assist the surgeon in manipulating trocar 33. It is noted that incisive tip 41 extends beyond the forward end 34 of sheath 12 when stylet 40 is fully inserted therein.
FIGS. 3 and 4 further illustrate resectroscope 10 which utilizes sheath 12 in common with trocar 33. Stylet 13 includes an elongate shaft 43 slidably received within tubular sheath 12 and having a flange 44 at the rearward end 45 thereof to provide a fingergrasp or thumb pad. Heating element 47 extends from the forward end 48 of elongate shaft 43. Heating element 47 is a loop of resistance wire formed into a hook. In accordance with the output of the power supply 11, a hook-shaped heating element fashioned from 0.015 inch diameter chromel wire or the equivalent thereof provides the correct resistance. Electric leads 21 are connected to the resistance wire as shown at 49. The insulative covering of electric leads 21 extends through tube 43 nearly to connection 49. Further insulation is provided by fabricating stylet 13 from a non-conductor, such as nylon. The stylet 13 may be alternately fabricated of metal and incorporate an insulative tip to receive the ends of resistance wire 47 in the exposed portions of electric leads 21. Elongate shaft 13 is longer than sheath 12 such that hook-shaped resistance element 47 may extend beyond the forward end 34 thereof. Compression spring 50, bearing against the rearward end 39 of sheath 12, urges stylet 13 rearward relative sheath 12 to a normal resting position wherein electric element 47 is fully encased within insulative end 35.
The performance of a laparoscopic tubal sterilization is best described with reference to FIGS. 5 and 6. After insufflation of the peritoneal cavity and introduction of the laparoscope, in accordance with standard medical procedure, trocar 33 is inserted through the abdominal wall. Tip 41 provides an incision for passage of the sheath 12 through the abdominal wall with tip 34 directed to the surgical area. Stylet 40 is then withdrawn from sheath 12.
With sheath 12 in place, stylet 13 is slidably inserted therein. As particularly seen in FIG. 5, shaft 43 of stylet 13 is longer than sheath 12 and as spring 50 is compressed, the hook-shaped electrical resistance element 47 extends beyond the forward end 34 of sheath 12. Electroresectroscope 10 is manipulated with heating element 47 held in the extended position until Fallopian tube, represented by dashed outline 52, is engaged by hook-shaped element 47. During the foregoing manipulation of electroresectroscope 10, the surgeon normally engages the index finger and middle finger under flange 38 and rests thumb upon disk-like pad 44 in a manner analogous to using a hypodermic needle.
When the surgeon's grip is relaxed, compression spring 50 expands, retracting the resistance element 47 and the doubled portion of Fallopian tube 52 engaged thereby within the insulative section 35 of tubular sheath 12. With resistance element 47 and the section of Fallopian tube 52 to be resected and coagulated thermoelectrically isolated from surrounding organs and tissues, foot switch 23 is depressed, applying electrical energy to resistance element 47. The heat produced as the electrical energy impulse passes through resistance element 47 removes a small section of Fallopian tube 52, coagulating the tube at either end of the resection to produce two fulgurated ends. In accordance with the construction of electroresectroscope 10, as previously described, resistance element 47 is a closed circuit and the electrical energy supplied thereto is localized at the operative area within the thermoelectric insulative shield 35.
It will be immediately apparent to those skilled in the art that the electroresectroscope apparatus and method as set forth in the foregoing specification substantially simplifies laparoscopic tubal sterilization. It is equally apparent that the electrosurgery as accomplished by the preferred embodiment of the electroresectroscope in a shielded environment with localized application of electrical energy prevents thermal burns to the patient, provides a greater degree of safety for the surgeon, and otherwise achieves the objectives previously set forth. Various changes and modifications to the particular apparatus herein shown are anticipated. Particular changes are foreseen in size and shape of devices, materials of construction, electrical energy requirements with regard to the resistance and desired output of the heating element, and other similar specifics which do not detract from the scope and intent of the invention.
|Cited Patent||Filing date||Publication date||Applicant||Title|
|US1731069 *||Jan 16, 1928||Oct 8, 1929||Surgical instrument|
|US2034785 *||Jul 12, 1935||Mar 24, 1936||Charles Wappler Frederick||Endoscopic forceps|
|US3805791 *||Jun 23, 1972||Apr 23, 1974||P Deyhle||Apparatus for the diathermic removal of growths|
|US3831607 *||Mar 7, 1973||Aug 27, 1974||Lindemann H||Electrocoagulation grasping forceps for tube sterilization by means of bipolar high frequency heat radiation|
|US3834392 *||Feb 1, 1973||Sep 10, 1974||Kli Inc||Laparoscopy system|
|US3870048 *||Jul 30, 1973||Mar 11, 1975||Yoon In Bae||Device for sterilizing the human female or male by ligation|
|US3938527 *||Jul 13, 1973||Feb 17, 1976||Centre De Recherche Industrielle De Quebec||Instrument for laparoscopic tubal cauterization|
|Citing Patent||Filing date||Publication date||Applicant||Title|
|US4311143 *||Oct 9, 1979||Jan 19, 1982||Olympus Optical Co., Ltd.||Apparatus for resecting tissue inside the body cavity utilizing high-frequency currents|
|US4565200 *||May 4, 1982||Jan 21, 1986||Cosman Eric R||Universal lesion and recording electrode system|
|US4811733 *||Dec 29, 1986||Mar 14, 1989||Baxter Travenol Laboratories, Inc.||Electrosurgical device|
|US4994061 *||Mar 6, 1989||Feb 19, 1991||Selvac Corporation||Hair grasping device|
|US5304124 *||Jun 7, 1993||Apr 19, 1994||Essig Mitchell N||Myoma removal technique|
|US5919191 *||Jan 30, 1997||Jul 6, 1999||Boston Scientific Corporation||Electro-surgical tissue removal|
|US6312426||May 30, 1997||Nov 6, 2001||Sherwood Services Ag||Method and system for performing plate type radiofrequency ablation|
|US6494881||Sep 30, 1997||Dec 17, 2002||Scimed Life Systems, Inc.||Apparatus and method for electrode-surgical tissue removal having a selectively insulated electrode|
|US6997926||Feb 4, 2002||Feb 14, 2006||Boston Scientific Scimed, Inc.||Resistance heated tissue morcellation|
|US7137979||Oct 2, 2003||Nov 21, 2006||Tyrell, Inc.||Methods and devices for the treatment of skin lesions|
|US7428904||May 14, 2004||Sep 30, 2008||Alien Technology Corporation||Contraceptive transcervical fallopian tube occlusion devices and their delivery|
|US7537605||May 3, 2003||May 26, 2009||Huan-Chen Li||Medical device for treating skin itch and rash|
|US7637930||Apr 15, 2005||Dec 29, 2009||Huanchen Li||Medical device and method for treating skin disease|
|US7686020||Aug 31, 2006||Mar 30, 2010||Conceptus, Inc.||Contraceptive transcervical fallopian tube occlusion devices and methods|
|US7921848||Aug 13, 2003||Apr 12, 2011||Conceptus, Inc.||Contraceptive transcervical fallopian tube occlusion devices and methods|
|US8066007||Jul 31, 2006||Nov 29, 2011||Conceptus, Inc.||Contraceptive transcervical fallopian tube occlusion devices and their delivery|
|US8171936||Oct 20, 2010||May 8, 2012||Conceptus, Inc.||Contraceptive transcervical fallopian tube occlusion devices and methods|
|US8327852||Nov 11, 2011||Dec 11, 2012||Conceptus, Inc.||Occlusion devices and methods|
|US8356599||Nov 11, 2011||Jan 22, 2013||Conceptus, Inc.||Occlusion devices and methods|
|US8613282||May 7, 2012||Dec 24, 2013||Conceptus, Inc.||Occlusion devices and methods|
|US8733360||Aug 20, 2012||May 27, 2014||Bayer Essure Inc.||Occlusion devices and methods|
|US8733361||Nov 19, 2012||May 27, 2014||Bayer Essure Inc.||Occlusion devices and methods|
|US9629658 *||Sep 2, 2014||Apr 25, 2017||Boston Scientific Neuromodulation Corporation||Systems and methods for making and using a lead introducer for an implantable electrical stimulation system|
|US20040127962 *||May 3, 2003||Jul 1, 2004||Huan-Chen Li||Medical device for treating skin itch and rash|
|US20040159324 *||Feb 12, 2004||Aug 19, 2004||Conceptus, Inc.||Contraceptive transcervical fallopian tube occlusion devices and their delivery|
|US20040163651 *||Feb 23, 2004||Aug 26, 2004||Conceptus, Inc.||Transcervical fallopian tube occlusion devices and their delivery|
|US20040200483 *||May 3, 2004||Oct 14, 2004||Faries Durward I.||Surgical drape and method of detecting fluid and leaks in thermal treatment system basins|
|US20040243021 *||Nov 5, 2002||Dec 2, 2004||Murphy John C.||Device for thermal stimulation of small neural fibers|
|US20040243181 *||Oct 2, 2003||Dec 2, 2004||Tyrell, Inc.||Methods and devices for the treatment of skin lesions|
|US20050172972 *||Apr 15, 2005||Aug 11, 2005||Conceptus, Inc.||Contraceptive transcervical fallopian tube occlusion devices and methods|
|US20050203596 *||Apr 15, 2005||Sep 15, 2005||Huan-Chen Li||Medical device and method for treating skin disease|
|US20070023534 *||Jul 24, 2006||Feb 1, 2007||Mingsheng Liu||Water-source heat pump control system and method|
|US20070062542 *||Nov 20, 2006||Mar 22, 2007||Nikolchev Julian N||Contraceptive transcervical fallopian tube occlusion devices and methods|
|US20070181867 *||Dec 20, 2006||Aug 9, 2007||Hewak Daniel W||Phase change memory materials, devices and methods|
|US20070265688 *||May 4, 2007||Nov 15, 2007||Huan-Chen Li||Medical device and method for treating skin disease|
|US20150073431 *||Sep 2, 2014||Mar 12, 2015||Boston Scientific Neuromodulation Corporation||Systems and methods for making and using a lead introducer for an implantable electrical stimulation system|
|EP0542428A1 *||Oct 14, 1992||May 19, 1993||Dexide, Inc.||Trocar instrument|
|International Classification||A61B17/34, A61B18/08, A61B17/42|
|Cooperative Classification||A61B18/085, A61B17/42, A61B17/3417|
|European Classification||A61B18/08B4, A61B17/34G, A61B17/42|
|May 19, 1986||AS||Assignment|
Owner name: MIDLANTIC NATIONAL BANK, METRO PARK PLAZA, PO BOX
Free format text: SPECIAL POWER OF ATTORNEY;ASSIGNOR:GYNECO, INC.;REEL/FRAME:004555/0083
Effective date: 19860319
Owner name: MIDLANTIC NATIONAL BANK, METRO PARK PLAZA, PO BOX
Free format text: SECURITY INTEREST;ASSIGNOR:GYNECO, INC.;REEL/FRAME:004555/0079
Effective date: 19860319